Speech Intelligibility and Psychosocial Functioning in Deaf Children and Teens with Cochlear Implants

Everything, altogether, all at once: Addressing data challenges when measuring speech intelligibility through entropy scores

When investigating unobservable, complex traits, data collection and aggregation processes can introduce distinctive features to the data such as boundedness, measurement error, clustering, outliers, and heteroscedasticity. Failure to collectively address these features can result in statistical challenges that prevent the investigation of hypotheses regarding these traits. This study aimed to demonstrate the efficacy of the Bayesian beta-proportion generalized linear latent and mixed model (beta-proportion GLLAMM) (Rabe-Hesketh et al., Psychometrika, 69(2), 167-90, 2004a, Journal of Econometrics, 128(2), 301-23, 2004c, 2004b; Skrondal and Rabe-Hesketh 2004) in handling data features when exploring research hypotheses concerning speech intelligibility. To achieve this objective, the study reexamined data from transcriptions of spontaneous speech samples initially collected by Boonen et al. (Journal of Child Language, 50(1), 78-103, 2023). The data were aggregated into entropy scores. The research compared the prediction accuracy of the beta-proportion GLLAMM with the normal linear mixed model (LMM) (Holmes et al., 2019) and investigated its capacity to estimate a latent intelligibility from entropy scores. The study also illustrated how hypotheses concerning the impact of speaker-related factors on intelligibility can be explored with the proposed model. The beta-proportion GLLAMM was not free of challenges; its implementation required formulating assumptions about the data-generating process and knowledge of probabilistic programming languages, both central to Bayesian methods. Nevertheless, results indicated the superiority of the model in predicting empirical phenomena over the normal LMM, and its ability to quantify a latent potential intelligibility. Additionally, the proposed model facilitated the exploration of hypotheses concerning speaker-related factors and intelligibility. Ultimately, this research has implications for researchers and data analysts interested in quantitatively measuring intricate, unobservable constructs while accurately predicting the empirical phenomena.

Language development in children from a public cochlear implant program

OBJECTIVE

To evaluate the rate of loss to follow-up in a cochlear implant program from the public health system in Southern Brazil as well as the characteristics of hearing loss, sociodemographic, sociocultural and the development of oral language in children with prelingual deafness.

METHODS

Retrospective cohort study with children who underwent CI surgery between 2010 and 2020. Data was collected through of interviews and review of medical records. The language development assessment was performed using the MUSS, MAIS and IT-MAIS scales. For the classification of language development, we used as parameters the values (mean ± SD) found in a previous national study. From those values, the Z-score for each patient at each hearing age (time of experience with the cochlear implant) was calculated.

RESULTS

Of the 225 children implanted between 2010-2020, 129 were included in this study. The rate of loss to follow-up in the program was 42.6%. The mean age at first surgery was 40.5 (±16.9) months, with 77.5% of patients having received a unilateral implant. Language results below the expected for hearing age (

CONCLUSIONS

Most patients had an elevated mean age at cochlear implantation and there was a high rate of loss to follow-up and low attendance to speech and programming sessions. An overall poor language performance was found for this pediatric cochlear implant program from the public health system in Southern Brazil.

LEVEL OF EVIDENCE

Level 3 (Non-randomized cohort study).

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Key Words

• Cochlear implant
• Language development disorders
• Prelingual deafness

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MESH Headings

• Humans
• Retrospective Studies
• Child, Preschool
• Male
• Female
• Brazil
• Language Development
• Cochlear Implants
• Cochlear Implantation
• Infant
• Deafness/surgery
• Child
• Socioeconomic Factors

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Affiliation(s)

Alice Lang Silva Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil.
Isadora Martins da Silva Stumpf Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Otorrinolaringologia, Porto Alegre, RS, Brazil
Laura Prolla Lacroix Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil
Debora Milena Ferreira Alves Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil
Adriana Laybauer da Silveira Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Fonoaudiologia, Porto Alegre, RS, Brazil
Sady Selaimen da Costa Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Otorrinolaringologia, Porto Alegre, RS, Brazil
Letícia Petersen Schmidt Rosito Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Otorrinolaringologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil

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Temperament in Toddlers With and Without Prelingual Hearing Loss

PURPOSE

The purpose of this study is to examine parent-reported ratings of temperament in toddlers with and without prelingual hearing loss.

METHOD

The parent-completed Early Childhood Behavior Questionnaire (ECBQ) was used to assess temperament in toddlers aged 18-36 months. Three dimensions of temperament were examined: surgency, negative affectivity, and effortful control. Analyses were conducted to (a) examine differences in temperament across toddlers with and without prelingual hearing loss; (b) examine possible associations between temperament, demographic, and communication factors; and (c) determine if the ECBQ is sensitive to differences in hearing, communication, and listening skills among toddlers with prelingual hearing loss.

RESULTS

The parent-completed ECBQ revealed that toddlers with prelingual hearing loss differed from their hearing peers on some but not all dimensions of temperament. Specifically, children with prelingual hearing loss were rated as displaying higher levels of surgency and lower levels of effortful control but comparable levels of negative affectivity when compared to their hearing peers. Regression analyses revealed that chronological age and communication strategy predicted scores of effortful control in toddlers with prelingual hearing loss, whereas chronological age alone predicted scores of effortful control in toddlers with hearing. Finally, the ECBQ appears to contain "listening" items that skew (lower) levels of effortful control in toddlers with prelingual hearing loss, such that only the group effect of higher levels of surgency remained after removing these "listening" items. Correlations between the original and our modified ECBQ (removing the "listening" items) revealed strong associations, reflective of high construct validity.

CONCLUSIONS

This was the first study to measure temperament in toddlers with prelingual hearing loss using the ECBQ. Our results revealed differences between children with and without prelingual hearing loss centering on the dimension of surgency. Examining differences in temperament during the toddler period of development may be particularly important and useful for predicting functional outcomes following prelingual hearing loss.

The effects of vestibular dysfunction on balance and self-concept in children with cochlear implants

OBJECTIVES

Children with cochlear implants (CCI) have an increased rate of vestibular dysfunction. Vestibular dysfunction is associated with decreased balance and dynamic visual acuity ability. Hearing loss alone is associated with reduced speech perception and vocabulary in children. In adults, vestibular dysfunction is associated with reduced quality of life; however, similar relationships have not been studied in children with vestibular dysfunction. Therefore, the objective of the present study was to evaluate the effect of hearing loss and vestibular dysfunction on self-concept in CCI (n = 33) compared to children with normal hearing (CNH, n = 38). It was hypothesized that children with vestibular dysfunction would have reduced self-concept beyond that from hearing loss, secondary to the presence of balance and visual acuity deficits.

METHODS

The Piers-Harris Children's Self-Concept Scale - 2, speech perception, vocabulary, video head impulse test (vHIT), rotary chair, balance using the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2), and dynamic visual acuity (DVA) testing were completed on all participants.

RESULTS

In the 34 CCI, 24 had normal vestibular function, 6 had unilateral vestibular dysfunction, and 4 had bilateral vestibular dysfunction. There were no significant mean differences in the Piers-Harris Children's Self-Concept Scale - 2 between groups. A Principal Component Analysis (PCA) was conducted on the predictor variables (average horizontal canal vHIT gain, BOT-2 score, DVA, speech perception, and vocabulary) resulting in two factors; factor 1 represented "vestibular" components (vHIT, BOT-2, and DVA) and factor 2 represented "auditory-language" components (speech perception and vocabulary). In addition to age and gender, the 2 PCA factors were analyzed using multivariate regression with stepwise selection to determine which factors best predicted self-concept. The PCA auditory-language factor was the only significant predictor of self-concept.

CONCLUSIONS

Auditory-language, not vestibular related factors, contribute to the self-concept of CCI. While adults with vestibular dysfunction have reduced quality of life, it could be that children with vestibular dysfunction have some psychosocial resilience.

Intelligibility of Word-Initial Obstruent Consonants in Mandarin-Speaking Prelingually Deafened Children With Cochlear Implants

PURPOSE

This study assessed the intelligibility of obstruent consonants in prelingually deafened Mandarin-speaking children with cochlear implants (CIs).

METHOD

Twenty-two Mandarin-speaking children with normal hearing (NH) aged 3.25-10.0 years and 35 Mandarin-speaking children with CIs aged 3.77-15.0 years were recruited to produce a list of Mandarin words composed of 17 word-initial obstruent consonants in different vowel contexts. The children with CIs were assigned to chronological age-matched (CA) and hearing age-matched (HA) subgroups with reference to the NH controls. One hundred naïve NH adult listeners were recruited for a consonant identification task that consisted of a total of 2,663 stimulus tokens through an online research platform. For each child speaker, the consonant productions were judged by seven to 12 different adult listeners. An average percentage of consonants correct was calculated across all listeners for each consonant.

RESULTS

The CI children in both the CA and HA subgroups showed lower intelligibility in their consonant productions than the NH controls. Among the 17 obstruents, both CI subgroups showed higher intelligibility for stops, but they demonstrated major problems with the sibilant fricatives and affricates and showed a different confusion pattern from the NH controls on these sibilants. Of the three places (alveolar, alveolopalatal, and retroflex) in Mandarin sibilants, both CI subgroups showed the lowest intelligibility and the greatest difficulties with alveolar sounds. For the NH children, there was a significant positive relationship between overall consonant intelligibility and chronological age. For the children with CIs, the best fit regression model revealed significant effects of chronological age and age at implantation, with their quadratic terms included.

CONCLUSIONS

Mandarin-speaking children with CIs experience major challenges in the three-way place contrasts of sibilant sounds in consonant production. Chronological age and the combined effect of CI-related time variables play important roles in the development of obstruent consonants in the CI children.

Spontaneous speech intelligibility: early cochlear implanted children versus their normally hearing peers at seven years of age

Speaking intelligibly is an important achievement in children's language development. How far do congenitally severe-to-profound hearing-impaired children who received a cochlear implant (CI) in the first two years of their life advance on the path to intelligibility in comparison to children with typical hearing (NH)? Spontaneous speech samples of children with CI and children with NH were orthographically transcribed by naïve transcribers. The entropy of the transcriptions was computed to analyze their degree of uniformity. The same samples were also rated on a continuous rating scale by another group of adult listeners. The transcriptions of the NH children's speech were more uniform, i.e., had significantly lower entropy, than those of the CI children, suggesting that the latter group displayed lower intelligibility. This was confirmed by the ratings on the continuous scale. Despite the relatively restricted age ranges, older children reached better intelligibility scores in both groups.

Speech intelligibility of children with an auditory brainstem implant: a triple-case study

Auditory brainstem implantation (ABI) is a relative recent development in paediatric hearing restoration. Consequently, young-implanted children's productive language has not received much attention. This study investigated speech intelligibility of children with ABI (N = 3) in comparison to children with cochlear implants (CI) and children with typical hearing (TH). Spontaneous speech samples were recorded from children representing the three groups matched on cumulative vocabulary level. Untrained listeners (N = 101) rated the intelligibility of one-word utterances on a continuous scale and transcribed each utterance. The rating task yielded a numerical score between 0 and 100, and similarities and differences between the listeners' transcriptions were captured by a relative entropy score. The speech intelligibility of children with CI and children with TH was similar. Speech intelligibility of children with ABI was well below that of the children with CI and TH. But whereas one child with ABI's intelligibility approached that of the control groups with increasing lexicon size, the intelligibility of the two other children with ABI did not develop in a similar direction. Overall, speech intelligibility was only moderate in the three groups of children, with quite low ratings and considerable differences in the listeners' transcriptions, resulting in high relative entropy scores.

Longitudinal effects of emotion awareness and regulation on mental health symptoms in adolescents with and without hearing loss

Emotion awareness (EA) and regulation (ER) are each known to associate with mental health symptoms, yet there is a paucity of longitudinal studies examining them jointly during adolescence. Furthermore, little is known about these skills and their relations in deaf and hard-of-hearing (DHH) adolescents, who are at risk for reduced emotion socialization and for more mental health symptoms. This longitudinal study examined the development and unique contributions of EA (emotion differentiation, emotion communication and bodily unawareness) and ER (approach, avoidance and worry/rumination) to internalizing and externalizing symptoms in adolescents with and without hearing loss. Using self- and parent's reports, we assessed 307 adolescents (age 9-15) three times over 18-month period. We found stability over time in development of EA and avoidance ER, increase in approach ER and decrease in worry/rumination. High levels and increases over time in two aspects of EA, emotion differentiation and communication, and in approach and avoidance ER were related to decreases in depressive symptoms. An increase in approach ER was also related to a decrease in anxiety symptoms. Yet, low levels or decreases in worry/rumination were related to decreased levels of depressive, anxiety and externalizing symptoms. Hearing loss did not moderate any of the variables or relations tested. Preliminary tests suggested heterogeneity within the DHH group according to educational placement, language abilities and parental education level. Overall, findings pointed at unique contributions of EA and ER to mental health development, suggesting that DHH adolescents, especially in mainstream schools, do not differ from their hearing peers in their emotion awareness and regulation.

Socio-Emotional Development of Children with Cochlear Implant: A Systematic Review

Background

Attaining socio-emotional competence is challenging for children with hearing impairment. There is wide recognition of children with cochlear implant (CI) indicating significant improvement in their speech and language abilities, however many factors may restrict their chance of having reciprocal social interactions. A significant improvement in speech and language does not automatically affirm the quality of social interactions. This present observation on social-emotional development addressed a more current representative population of children with hearing loss who have benefitted from cochlear implantation.

Methods

The research conducted a systematic review of selected articles from Scopus and PubMed databases, retrieved through three search-process keywords, namely socio-emotional, children and CI. The inclusion criteria only included journal articles published in English with empirical data from the year 2010-2019. The initial search had identified 189 potential abstracts and after removal of duplicates, only 38 eligible studies met the inclusion criteria.

Results

Among 38 studies reviewed, 19 studies showed comparable socio-emotional skills with peers in social interaction, empathy, emotion theory of mind and comprehension skills. Conversely, the other 19 studies presented underprivileged results in socio-emotional functioning mainly in identifying facial expression, regulating emotion and emotional cues in the auditory domain.

Conclusion

This review concluded that the socio-emotional development among children with CI, both at preschool-age and school-age, was not justified due to the heterogeneity in studies across measurement and small sample size. Also, the conclusion recommended extensive cross-referencing, mixed-mode research design, detailed distinguishing of socio-emotional functioning and identification of diverse groups of the population with impaired hearing as an approach to provide empirical evidence on socio-emotional functioning among children with CI in the future.

Predicting Quality of Life and Behavior and Emotion from Functional Auditory and Pragmatic Language Abilities in 9-Year-Old Deaf and Hard-of-Hearing Children

Children who are deaf or hard of hearing (DHH) are likely to exhibit difficulties in development of psychosocial skills, pragmatic language skills, and use of hearing for social communication in real-world environments. Some evidence suggests that pragmatic language use affects peer-relationships and school engagement in these children. However, no studies have investigated the influence of functional auditory performance and use of language and speech in real-world environments on children's behavior and emotion, and on their health-related quality of life. This study explored the relationship in DHH children at 9 years of age. Data from 144 participants of the Longitudinal Outcomes of Children with Hearing Impairment study were analyzed. Parent reports were obtained on quality of life, behavior and emotion, pragmatic language skills, and auditory functional performance of children in real life. Children's spoken language abilities and speech intelligibility were assessed by research speech pathologists. On average, performance of children in all domains was within the range of typically developing peers. There were significant associations among functional auditory performance, use of speech and language skills, psychosocial skills, and quality of life. Multiple linear regression analyses revealed that better auditory functional performance and pragmatic language skills, rather than structural language abilities, were associated with better psychosocial abilities and quality of life. The novel findings highlight the importance of targeted intervention for improving functional hearing skills and social communication abilities in DHH children, and emphasize the importance of collaborative approaches among medical, audiology, allied health, and educational professionals to identify those at risk so that timely referral and intervention can be implemented for improving psychosocial health and well-being in DHH children.

Collaboration Between Child Play Therapy and Speech-Language Pathology: Case Reports of a Novel Language and Behavior Intervention

Purpose It has been well documented that a significant number of children with developmental language disorders (DLDs) also exhibit challenging behaviors. In this study, a new intervention (Play and Language [PAL]) was developed through a research collaboration between a speech-language pathologist and a play therapist. The purpose of this clinical focus article is to describe child play therapy techniques and how these, along with early language intervention techniques, may positively impact preschool children's general communication and behavior. Method Students in a communication sciences and disorders program were trained to use a combination of child therapy techniques and language facilitation procedures in the PAL approach. Five preschool children, who displayed DLD and challenging behaviors, participated in a 2-week daily intensive intervention. Pre- and postintervention data for general communication and behavior skills were collected through parent report and language sample data. Student clinician and parent surveys were collected to assess the feasibility of conducting the new intervention and the parent-observed outcomes and satisfaction. Results A majority of the children who participated in the study increased their intelligibility and number of different words. Fewer than half increased their sentence length. These same children decreased their challenging behaviors, with 11 of 14 behaviors being reduced to normal levels. All parents reported satisfaction with their child's results. In addition, students trained to provide the intervention reported high levels of satisfaction with the training to implement PAL and that they were confident in providing the intervention techniques. Conclusion Together, our exploratory data provide preliminary and limited evidence that combining play therapy and language facilitation techniques may improve general communication skills and decrease challenging behaviors within the same intervention. Supplemental Material https://doi.org/10.23641/asha.16840459.

Family Environment in Children With Hearing Aids and Cochlear Implants: Associations With Spoken Language, Psychosocial Functioning, and Cognitive Development

OBJECTIVES

To examine differences in family environment and associations between family environment and key speech, language, and cognitive outcomes in samples of children with normal hearing and deaf and hard-of-hearing (DHH) children who use hearing aids and cochlear implants.

DESIGN

Thirty families of children with normal hearing (n = 10), hearing aids (n = 10), or cochlear implants (n = 10) completed questionnaires evaluating executive function, social skills, and problem behaviors. Children's language and receptive vocabulary were evaluated using standardized measures in the children's homes. In addition, families were administered a standardized in-home questionnaire and observational assessment regarding the home environment.

RESULTS

Family environment overall was similar across hearing level and sensory aid, although some differences were found on parental responsivity and physical environment. The level of supportiveness and enrichment within family relationships accounted for much of the relations between family environment and the psychosocial and neurocognitive development of DHH children. In contrast, the availability of objects and experiences to stimulate learning in the home was related to the development of spoken language.

CONCLUSIONS

Whereas broad characteristics of the family environments of DHH children may not differ from those of hearing children, variability in family functioning is related to DHH children's at-risk speech, language, and cognitive outcomes. Results support the importance of further research to clarify and explain these relations, which might suggest novel methods and targets of family-based interventions to improve developmental outcomes.

Inteligibilidad: diferentes perspectivas de su concepto y evaluación. Una revisión sistemática

Una adecuada inteligibilidad es un indicador del éxito en la comunicación. Su interferencia, a causa de cualquier patología, debe ser abordada en los objetivos primordiales de la terapia. No obstante, los métodos para su evaluación son poco conocidos. Objetivo: desarrollar una revisión sistemática que describa los métodos empleados en la medición de la inteligibilidad y discutir la conceptualización de este constructo. Metodología: se realiza una búsqueda en las bases de datos PubMed, ScieLo y Science Direct para identificar artículos publicados entre 1990 y 2018. Análisis y discusiones: Se seleccionan 50 investigaciones en inglés, español y portugués, que mostraron preferencia por medidas objetivas de evaluación, por sobre las medidas subjetivas de escala. La inteligibilidad se define mejor como un constructo dependiente de la señal acústica, a diferencia del concepto de comprensibilidad. Esta revisión ofrece información actualizada y organizada para optimizar procedimientos clínicos y científicos de medición de la inteligibilidad. 

Native and non-native listeners' judgements on the overall speech quality of hearing-impaired children

This study focuses on the influence of listeners' native language on their judgement of the overall speech quality of normally hearing (NH) and hearing-impaired (HI) children. Studies have shown that listeners' native language influences their judgements on linguistic aspects of a foreign language. Since judging speech quality does in principle not require any knowledge of the language, the question arose if the native language influences listeners' judgements. For this purpose, the overall speech quality of seven-year-old Dutch speaking children (n = 21) with an acoustic hearing aid (HA), a cochlear implant (CI) and normal hearing (NH) was judged by four listener groups (native speakers of Italian, German, French and Dutch). Listeners completed a comparative judgement task in which stimuli were presented in pairs. For each pair, they selected the better sounding stimulus. This procedure ultimately led to a ranking of the stimuli according to their speech quality. The ranking showed that NH children had a significantly higher speech quality than HI children. Interestingly, there was no significant effect of language background. Both native and non-native listeners perceived a significant difference in speech quality. Also, within the group of HI children, all listener groups preferred the speech of CI children when comparing them to HA children. These results indicated that the differences were purely speech related since the non-native listeners had no linguistic knowledge of Dutch. Considering that all listeners perceived a similar qualitative difference, we conclude that there was no transfer of native language in this type of judgement.

Pragmatics and Peer Relationships Among Deaf, Hard of Hearing, and Hearing Adolescents

OBJECTIVES

The goals of the current study were to (1) examine differences in pragmatic abilities and peer relationship behaviors among deaf and hard of hearing (DHH) adolescents who use spoken language, in comparison with their hearing peers; and (2) explore the contribution of pragmatic skills and speech (ie, articulation and intelligibility [AI]) to social aspects of school functioning among DHH and typically hearing adolescents.

METHODS

Thirty-three DHH adolescents and 34 adolescents with typical hearing participated. All DHH adolescents attended mainstream school settings and used spoken language. Teacher reports were obtained on prosocial behaviors, peer problems, pragmatic abilities, and speech AI of the adolescents. Adolescents self-reported on the supportiveness of their peer relationships and their school emotional engagement.

RESULTS

Multiple hierarchical regression analyses revealed that DHH adolescents had greater difficulties with peers than their hearing counterparts. Increased pragmatic difficulties were related to more peer problems and decreased prosocial behaviors, regardless of adolescents' hearing status. A significant positive correlation was found between pragmatic competence and adolescents' perceptions of peers' support. Finally, better speech AI were associated with higher levels of school emotional engagement.

CONCLUSIONS

The results emphasize the significant role of pragmatics for both DHH and typically hearing adolescents. Medical care providers and allied health professionals should be aware of possible difficulties that DHH adolescents may have in complex and nuanced pragmatic skills. Some adolescents may require a referral to specialized services to support the development of their pragmatic understanding and their skills.

Is the spontaneous speech of 7-year-old cochlear implanted children as intelligible as that of their normally hearing peers?

OBJECTIVES

Studies on speech intelligibility usually focus on either individual words, sentences or longer sequences of speech. Since these different kinds of speech samples can be judged using different methodologies, a difference in the reported intelligibility scores can either be due to the difference in the type of sample or methodology. The present study compares the speech intelligibility of seven-year-old children with a cochlear implant (CI) with that of their normally hearing (NH) peers. The first aim is to compare the intelligibility of short sentences and longer sequences of speech using the same methodology. Secondly, it has been suggested that i.a. advances in CI technology and changes in candidacy criteria may have had a positive influence on the intelligibility of children with CI. In order to assess this issue, the intelligibility of seven-year-olds implanted ten years apart will be compared.

METHOD

The speech of two cohorts of early implanted children with CI (n = 16) and NH peers (n = 16), matched on several criteria but implanted in different years, was collected. More specifically, short and longer samples were selected from recordings of a wordless picture book retelling. Both types of samples were judged on a visual analogue scale by 105 inexperienced listeners.

RESULTS

The results showed that the intelligibility of children with CI was lower than that of their NH peers. Moreover, longer samples were significantly more intelligible than short samples for both groups. No significant effect was found between the two cohorts of children with CI. However, the intelligibility of three out of four children with CI was found to be on a par with that of their NH peers, indicating a large amount of variability between subjects.

CONCLUSION

Listeners ascribed higher intelligibility to longer samples than to short samples, despite the fact that both types were extracted from the same recordings and listeners followed the same judgement procedure. The amount of context thus facilitated speech decoding. No effect of the calendar year of implantation was found, suggesting that e.g., the evolution in CI technology did not have a significant impact on CI users' intelligibility after six years of device use.

Health-related quality of life in children who use cochlear implants or hearing aids

Objectives

First, this study aimed at evaluating the health-related quality of life (HRQoL) and socio-demographic characteristics of children with cochlear implants (CIs) and hearing aids (HAs) from the 2 provinces of the Canary Islands (Spain) on the Kid-KINDL^R_children_7–13. The second goal was to analyze parental background factors and the perspectives of their children with CIs and HAs on Kid_Kiddo-KINDL^R_Parents_ 7–17. Finally, the third objective was to explore agreement between children's self-reports and their parents' reports concerning HRQoL.

Design

The data consisted of 89 children with CIs and 63 children with HAs and their 89 parents, respectively. The socio-demographic characteristics of children and parental background factors included demographic and audiological variables. Student's t-test, one-way ANOVA, post hoc analysis and 4 concordance correlation coefficients (CCC) were used to address the 3 aims.

Results

Children with CIs exhibited a perception of better HRQoL in comparison with children with HAs. Among other differences, children with CIs and HAs and their parents were significantly distinct in Setting (i.e., provinces of Tenerife and Gran Canaria) (t = 2.921, p < 0.010). Moreover, parents were significantly different in some background factors (i.e., age, socioeconomic status, and learning). While Cohen's Kappa values for most dimensions were too small, the ICC and Student's t-test expressed only concordance in the overall HRQoL and Physical well-being.

Conclusions

Children with CIs and their parents demostrated a perception of better HRQoL than children with HAs and their parents. Overall, children's self-ratings of HRQoL differed from their parents' reports.

Assessing Higher Order Language Processing in Long-Term Cochlear Implant Users

Purpose The purpose of this study was to describe and explain individual differences in complex/higher order language processing in long-term cochlear implant (CI) users relative to normal-hearing (NH) peers. Method Measures of complex/higher order language processing indexed by the Clinical Evaluation of Language Fundamentals-Fourth Edition (CELF-4) Core Language subtests were obtained from 53 long-term (≥ 7 years) CI users aged 9-29 years and 60 NH controls who did not differ in age, gender, or nonverbal IQ. Vocabulary knowledge and fast, automatic language processing (rapid phonological coding, verbal rehearsal speed, and speech intelligibility) were also assessed. Results CI users showed weaker performance than NH controls on all CELF-4 Core Language subtests. These differences remained for Formulated Sentences and Recalling Sentences even when vocabulary knowledge was statistically controlled. About 50% of the CI sample scored within the range of the NH sample on Formulated Sentences and Recalling Sentences, while the remaining 50% scored well below the NH sample on these subtests. Vocabulary knowledge, rapid phonological coding, verbal rehearsal speed, and speech intelligibility were more strongly correlated with CELF-4 subtest scores in the CI sample than in the NH sample. Conclusions Weaknesses in complex, higher order language processing shown by a subgroup of CI users compared to NH peers may result from delays in fast, automatic processing of language. These at-risk domains of language functioning could serve as targets for novel interventions for deaf children who experience suboptimal spoken language outcomes following cochlear implantation.

Psychosocial Outcomes in Long-Term Cochlear Implant Users

OBJECTIVES

The objectives of this study were to investigate psychosocial outcomes in a sample of prelingually deaf, early-implanted children, adolescents, and young adults who are long-term cochlear implant (CI) users and to examine the extent to which language and executive functioning predict psychosocial outcomes.

DESIGN

Psychosocial outcomes were measured using two well-validated, parent-completed checklists: the Behavior Assessment System for Children and the Conduct Hyperactive Attention Problem Oppositional Symptom. Neurocognitive skills were measured using gold standard, performance-based assessments of language and executive functioning.

RESULTS

CI users were at greater risk for clinically significant deficits in areas related to attention, oppositional behavior, hyperactivity-impulsivity, and social-adaptive skills compared with their normal-hearing peers, although the majority of CI users scored within average ranges relative to Behavior Assessment System for Children norms. Regression analyses revealed that language, visual-spatial working memory, and inhibition-concentration skills predicted psychosocial outcomes.

CONCLUSIONS

Findings suggest that underlying delays and deficits in language and executive functioning may place some CI users at a risk for difficulties in psychosocial adjustment.

Attitudes Toward Deafness Affect Impressions of Young Adults With Cochlear Implants

This study continues a project on speech-based impressions of early-implanted cochlear implant (CI) users. It examined relationships between listeners' attitudes or personal traits and how they judged CI users upon hearing their speech. College students with typical hearing (TH) listened to speech samples from CI users and TH young adults and rated the speakers' personalities and attractiveness as friends. CI users varied in speech intelligibility (proportion of words recognized by transcribers in prior work). Overall, listeners rated TH speakers most positively, CI users with high intelligibility (CI-Hi) as intermediate, and CI users with lower intelligibility (CI-Lo) most negatively. Listeners also completed questionnaires about their personalities, values, and attitudes toward deafness. Listeners with more positive attitudes toward deaf people rated both CI user groups more positively, and listeners whose personality and values questionnaires showed more tolerance and openness to interpersonal differences rated CI-Lo speakers more positively. These patterns underline the social importance of CI users' speech intelligibility while bringing to light the role of listeners' pre-existing attitudes in forming negative first impressions, which could impact CI users' friendships with TH peers. Because listeners' attitudes reflected ignorance about deaf people's abilities, this study calls for increased education about deafness for TH students.

Speech Intelligibility and Personality Peer-ratings of Young Adults With Cochlear Implants

Speech intelligibility, or how well a speaker's words are understood by others, affects listeners' judgments of the speaker's competence and personality. Deaf cochlear implant (CI) users vary widely in speech intelligibility, and their speech may have a noticeable "deaf" quality, both of which could evoke negative stereotypes or judgments from peers. In this study, college students with typical hearing (TH) used semantic differential scales to rate speech samples of highly-intelligible TH young adults and age-matched CI users with high or low intelligibility (CI-Hi, CI-Lo) on personality traits related to competence (intelligence, achievement), friendship skills (friendliness, popularity), and attractiveness as a friend (extraversion, dependability). Judges rated TH positively, CI-Lo negatively, and CI-Hi as intermediate, even though CI-Hi were as intelligible as TH. Both CI user groups were rated as friendly but unattractive as friends (insecure, shy, boring, unpopular, does not "sound like someone who could be my friend"), underlining the role of deaf speech quality in peer judgments. Such negative first impressions are likely to affect CI users' social interactions and friendships, highlighting the importance of speech intelligibility and quality for CI users and calling for education on deafness and deaf speech for TH peers.

Speech rate, rate-matching, and intelligibility in early-implanted cochlear implant users

An important speech-language outcome for deaf people with cochlear implants is speech intelligibility-how well their speech is understood by others, which also affects social functioning. Beyond simply uttering recognizable words, other speech-language skills may affect communicative competence, including rate-matching or converging toward interlocutors' speech rates. This initial report examines speech rate-matching and its relations to intelligibility in 91 prelingually deaf cochlear implant users and 93 typically hearing peers age 3 to 27 years. Live-voice spoken sentences were repeated and later transcribed by multiple hearing listeners. Speech intelligibility was calculated as proportions of words correctly transcribed. For speech rate-matching measures, speech rates (syllables/s) were normalized as percentages faster or slower than examiners' speech rates. Cochlear implant users had slower speech rates, less accurate and less consistent rate-matching, and poorer speech intelligibility than hearing peers. Among cochlear implant users, speech rate and rate-matching were correlated with intelligibility: faster talkers and better rate-matchers were more intelligible. Rate-matching and intelligibility improved during preschool, with cochlear implant users delayed by about a year compared to hearing peers. By school-age, rate-matching and intelligibility were good overall, but delays persisted for many cochlear implant users. Interventions targeting rate-matching skills are therefore warranted in speech-language therapy for this population.